Provider Demographics
NPI:1073650552
Name:INNES, SNEHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SNEHA
Middle Name:
Last Name:INNES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 NE HARVEST HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3647
Mailing Address - Country:US
Mailing Address - Phone:707-864-9904
Mailing Address - Fax:
Practice Address - Street 1:25647 REDWOOD HWY
Practice Address - Street 2:
Practice Address - City:CAVE JUNCTION
Practice Address - State:OR
Practice Address - Zip Code:97523-9332
Practice Address - Country:US
Practice Address - Phone:541-471-4111
Practice Address - Fax:541-592-3916
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54789122300000X
UT11417672-9921122300000X
ORD11608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11417672-9921OtherDDS LICENSE
ORD11608OtherDDS LICENSE
CA54789OtherDDS LICENSE